Splenic metastasis of hepatocellular carcinoma

A 76-year-old man, who underwent central bisegmentectomy of the liver, transcatheter arterial chemoembolization, and radiofrequency ablation for chronic hepatitis C virus-related hepatocellular carcinoma (HCC), was found to have a 3 cm mass in the spleen and a 2 cm mass in the liver by computed tomography in January 2003. As both tumors were adjacent, a diagnosis of HCC with splenic infiltration was made. In February 2003, transcatheter arterial chemoembolization and splenic arterial chemo-infusion were performed. However, the splenic tumor increased to 5 cm with slight enhancement on contrast-enhanced computed tomography performed 6 months later, while the hepatic tumor had no enhancement. Limited resection of the liver with splenectomy was performed in October 2003. Macroscopically, the splenic tumor showed infiltrative growth without a capsule while the hepatic tumor showed complete necrosis within its capsule. The splenic tumor was limited to the splenic parenchyma. Histologic examination revealed that the splenic tumor was poorly differentiated HCC, leading to the diagnosis of splenic metastasis. The patient is doing well 17 months after surgery without recurrence. One should perform surgery for splenic metastasis of HCC without hesitation whenever possible.